oedematous
congested
mass Thrombosed
purplish
digital rectal exam - VERY PAINFUL ! tight spasm of the anal sphincter
Both thrombosed and strangulated present with acute
pain
even more painful
necrotic
can become mass
ulcerated Strangulated Acute Presentations
leads to the formation of a solitary ulcer Conservative Management and meningkatkan tekanan abdomen
repititive straining
posterior wall of of the proximal anal canal Prevention of Haemorrhoids
symptoms can often be relieved by the patient obstruksi venous return
replacing the prolapsing haemorrhoids digitally after
defaecation 3rd degree haemorrhoids
plexus vena menjadi membesar
useful as temporary measure
do nothing to treat the underlying condition creams Pathogenesis mukosa bulging lalu dibawa oleh feses yg keras ke arah
may even cause local allergic reactions distal
contain local anaesthetic agents or steroids suppositories treatment
arteri characteristic bright red rectal bleeding
maceration of the perianal skin topical preparations bleed
overuse venous component causes problem ONLY if it becomes thrombosed thrombosed external venous saccule
predisposes to secondary infection
Haemorrhoids may prolapse
mucus
dietary change cause slight leakage
do not regress by 1st degree which faecal
avoiding straining particularl...
which?
most 2nd degree
Haemorrhoids When viewed
supine
position
what? Injection of Sclerosants lithotomy
outpatient basis 3
Located at
does not require any anaesthetic Sclerotherapy 7 o'clock positions
how? 11
to obliterate the haemorrhoidal vessels
on the paper
rectal bleeding
acutely painful Symptoms and Signs common chronic or intermittent seperate from the stool
sudden haemorrhoidal prolapse
persistent pain lasting 1-2 weeks mucus leakage
if untreated onset imperfect closure of anal cushions
worse on defaecation Mild incontinence of flatus
blue-black hemispherical bulge on examination essential
near anal margin Thrombosed External Haemorrhoids Digital Examination exclude carcinoma
subside over a few days useful measure of anal tone
patients need only oral analgesia Proctoscopy demostrate internal piles
most
thrombosis may be incised and drained under local seen bulging into the l...
Investigation
anaesthesia
important in patient over 40 years
Subtopic 4 Sigmoidoscopy
occassionally rectal polyp is diagnosed this way